Provider Demographics
NPI:1548237407
Name:MANUEL C BULAUITAN MDPC
Entity Type:Organization
Organization Name:MANUEL C BULAUITAN MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BULAUITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-291-9384
Mailing Address - Street 1:177-06 WEXFORD TERRACE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA ESTATES
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2927
Mailing Address - Country:US
Mailing Address - Phone:718-291-9384
Mailing Address - Fax:718-558-9020
Practice Address - Street 1:177-06 WEXFORD TERRACE
Practice Address - Street 2:
Practice Address - City:JAMAICA ESTATES
Practice Address - State:NY
Practice Address - Zip Code:11432-2927
Practice Address - Country:US
Practice Address - Phone:718-291-9384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121369173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
93385Medicare ID - Type Unspecified